INDIANAPOLIS -- Although more and more drug advertisements are appearing on television, the bulk of the approximately $21 billion dollars that pharmaceutical companies spend annually to market their products is targeted to physicians, doctors in training (residents) and medical students.

A literature review by researchers from the Indiana University School of Medicine and the Regenstrief Institute, Inc. published in the December issue of the journal Pediatrics focuses on the interaction between drug companies, medical students and residents and concludes that well-designed seminars, role playing and focused curricula can affect medical student and resident attitudes and behavior toward drug companies.

The review, led by Dr. Aaron E. Carroll, assistant professor of pediatrics with the Children's Health Services Research at the IU School of Medicine and a Regenstrief Institute affiliated scientist, scrutinized the recent literature in the field. Carroll and colleagues found 12 studies since 1991 focusing on the efforts of academic medical centers to modify the relationship between pharmaceutical companies and medical students and residents.

"Not surprisingly, we found that the greatest impact medical schools had on the interaction of medical students and residents with drug companies was if the school banned all contact with company representatives. But even requiring medical students or residents to participate in one hour of training had an impact on the relationship," said Carroll, who is also with Riley Hospital for Children, a Clarian Health Partner.

The study authors reported evidence that policy decisions to restrict contact between trainees and the pharmaceutical industry were associated with greater skepticism toward information given by drug company product representatives and altered behavior in future contact with drug company representatives.

"Doing nothing is no longer an acceptable option. Medical schools need to bring up the complex financial, medical and ethical issues involved in the interactions between doctors and drug companies. Fortunately doing almost anything seems to have at least a minimal impact," said Carroll.

Co-authors of the study are Dr. Rachel Vreeman and Jennifer Buddenbaum of the IU School of Medicine's Department of Pediatrics and Dr. Thomas Inui, president and CEO of Regenstrief Institute and Sam Regenstrief Professor of Health Services Research; Professor of Medicine and associate dean for health care research, IU School of Medicine.